Der Schmerz
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Most patients with amputation (up to 80 %) suffer from phantom limb pain postsurgery. These are often multimorbid patients who also have multiple risk factors for the development of chronic pain from a pain medicine perspective. Surgical removal of the body part and sectioning of peripheral nerves result in a lack of afferent feedback, followed by neuroplastic changes in the sensorimotor cortex. The experience of severe pain, peripheral, spinal, and cortical sensitization mechanisms, and changes in the body scheme contribute to chronic phantom limb pain. Psychosocial factors may also affect the course and the severity of the pain. Modern amputation medicine is an interdisciplinary responsibility. ⋯ Consequent prevention and treatment of severe postoperative pain and early integration of pharmacological and nonpharmacological interventions are required to reduce severe phantom limb pain. To obtain or restore body function, foresighted surgical planning and technique as well as an appropriate interdisciplinary management is needed.
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Cluster headache (CH) is a highly debilitating headache disorder characterized by frequent attacks of excruciating unilateral pain accompanied by cranial autonomic symptoms. Calcitonin gene-related peptide (CGRP) is implicated in the pathophysiology of CH. ⋯ Galcanezumab had a significant effect in the prevention of eCH attacks but not in cCH. Possible reasons for this discrepancy are discussed.
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In the field of headache disorders, the term "fear of attacks" refers to the fear of a headache attack occurring. Excessive fear of attacks may worsen the course of a migraine and lead to an increase in migraine activity. In the assessment of attack-related fear, a categorical (fear of attacks as a specific phobia) and a dimensional approach (measuring the extent of fear using a questionnaire) are available. ⋯ The treatment of attack-related fear includes behavioral interventions as well as pharmacological therapy. Behavioral interventions have few side effects and are based on the treatment of common anxiety disorders (e.g., agoraphobia). Although the evidence of existing treatments is sparse, attack-related fear should be considered in routine care.
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A theological perspective on dealing with crises that focuses on modes of endurance and gestalt, is supported by interdisciplinary resilience research. ⋯ In order for silence to promote resilience, it is necessary to keep an eye on productive as well as destructive processes of silence as an ambivalent phenomenon: These processes occur in an uncontrollable way and are shaped by implicit normative assumptions. Silence can be experienced as loneliness, isolation and the loss of quality of life, or silence can become a place of encounter, of arrival, of security, and in prayer of trust in God.
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The article provides an overview of the research project "Metaphor in end-of-life care", which was conducted at Lancaster University (UK) between 2011 and 2014. The goals of the project were to show a) how patients, family members and healthcare professionals use metaphors to talk about their experiences with and expectations of end-of-life care, b) what experiences and needs are suggested by the use of metaphors by these groups and c) what contribution the results can make to communication in the healthcare system. ⋯ The use of metaphors by these groups suggests a need for solidarity and community and reflects both positive and negative personal experiences. Resilience can be understood as resistance against illness or as acceptance of it.